首頁(yè) 資訊 《中華物理醫(yī)學(xué)與康復(fù)雜志》：瑜伽輔助應(yīng)用于臨床康復(fù)治療的國(guó)外研究進(jìn)展（王會(huì)儒）.pdf

《中華物理醫(yī)學(xué)與康復(fù)雜志》：瑜伽輔助應(yīng)用于臨床康復(fù)治療的國(guó)外研究進(jìn)展（王會(huì)儒）.pdf

來(lái)源：泰然健康網(wǎng) 時(shí)間：2024年12月04日 00:12

·712· 中華物理醫(yī)學(xué)與康復(fù)雜志2015年9月第37卷第9期Chin J Phys Med Rehabil,September2015,Val.37.No.9 .綜述· 瑜伽輔助應(yīng)用于臨床康復(fù)治療的國(guó)外研究進(jìn)展 王會(huì)儒顧問(wèn) 源自印度的瑜伽與中國(guó)太極拳一樣，注重身心整合，有研究 of1ife,WHOQOL)、知覺(jué)壓力量表和直腿抬高試驗(yàn)對(duì)2組患者的 證實(shí)，瑜伽練習(xí)不僅可以改善運(yùn)動(dòng)系統(tǒng)、神經(jīng)內(nèi)分泌系統(tǒng)、心血 生命質(zhì)量和腰部功能進(jìn)行了評(píng)測(cè)和相關(guān)性分析9，結(jié)果發(fā)現(xiàn)， 管系統(tǒng)和呼吸系統(tǒng)的功能，還具有增強(qiáng)免疫力、調(diào)節(jié)心理狀態(tài)的 CLBP患者的生命質(zhì)量和壓力呈負(fù)相關(guān)，瑜伽組患者生命質(zhì)量和 效果21。在美國(guó)，瑜伽已成為補(bǔ)充替代醫(yī)學(xué)的重要組成部分， 腰部功能均顯著優(yōu)于物理鍛煉組，差異均有統(tǒng)計(jì)學(xué)意義(P< 應(yīng)用于多種疾病的干預(yù)，如慢性腰痛(chronic low back pain, 0.01)。 CLBP)、類風(fēng)濕性關(guān)節(jié)炎(rheumatoid arthritis,RA)、膝關(guān)節(jié)骨性 艾揚(yáng)格瑜伽(Iyengar Yoga)是美國(guó)和歐洲最流行的瑜伽種 關(guān)節(jié)炎(knee osteoarthritis,KOA)、高血壓、冠心病、2型糖尿病、 類之一to。Williams等山將CLBP患者60例隨機(jī)分為艾揚(yáng)格 乳腺癌等的輔助治療與康復(fù)[35]。本文針對(duì)瑜伽練習(xí)對(duì)各種疾 瑜伽組和健康教育組，艾揚(yáng)格瑜伽練習(xí)組的訓(xùn)練項(xiàng)目包括仰臥， 病的治療效果及其國(guó)外相關(guān)研究進(jìn)行綜述，旨在為國(guó)內(nèi)醫(yī)務(wù)工 坐姿、站立、前屈，扭轉(zhuǎn)和反轉(zhuǎn)等29種體式，其中不包括向后彎 作者的臨床治療和科學(xué)研究提供參考。 屈動(dòng)作，健康教育組則僅進(jìn)行健康教育，2組均干預(yù)16周，并于 干預(yù)結(jié)束15周后評(píng)價(jià)其功能性障礙程度、疼痛強(qiáng)度、用藥、疼痛 瑜伽與CLBP 相關(guān)的態(tài)度和行為以及脊柱運(yùn)動(dòng)范圍等，結(jié)果發(fā)現(xiàn)，艾揚(yáng)格瑜伽 CLBP是指一組以下背，腰骶和臀部疼痛、不適為主要癥狀 組患者的疼痛強(qiáng)度與脊柱功能均顯著優(yōu)于健康教育組，差異均 的綜合征，是康復(fù)科和骨科的常見(jiàn)疾病之一。Sherman等61將 有統(tǒng)計(jì)學(xué)意義(P<0.01)。 228例腰疼痛患者分為瑜伽練習(xí)組、伸展操練習(xí)組和自我保健 還有研究嘗試將哈他瑜伽(Hatha Yoga)應(yīng)用于CLBP患者。 書籍學(xué)習(xí)組，3組患者根據(jù)分組情況分別進(jìn)行瑜伽練習(xí)、伸展操 Saper等2I在波士頓2個(gè)多種族低收入社區(qū)招募了中等程度的 練習(xí)和自我保健，每日1次，每次20min,連續(xù)治療12周.并于 CLBP患者30例（平均年齡44歲，女性及黑人為主），將其分為 入組后第26周采用Roland功能障礙問(wèn)卷(Roland and Morris 瑜伽治療組和常規(guī)護(hù)理組，瑜伽治療組每周進(jìn)行1次哈他瑜伽 disability questionnaire,RMDQ)進(jìn)行隨訪評(píng)價(jià)，結(jié)果發(fā)現(xiàn)，瑜伽練 干預(yù)，每次75min,連續(xù)于預(yù)12周，常規(guī)護(hù)理組則進(jìn)行連續(xù)12 習(xí)組和伸展操練習(xí)組的疼痛改善狀況顯著優(yōu)于自我保健書籍學(xué) 周的常規(guī)護(hù)理，結(jié)果顯示，哈他瑜伽組忠者的疼痛程度和鎮(zhèn)痛藥 習(xí)組，差異有統(tǒng)計(jì)學(xué)意義(P<0.01),但瑜伽練習(xí)組和伸展操練 服用劑量均顯著改善，與常規(guī)護(hù)理組比較，差異均有統(tǒng)計(jì)學(xué)意義 習(xí)組2組間比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。Pushpika (P<0.01)。英國(guó)Tilbrook等]也進(jìn)行了類似的隨機(jī)對(duì)照研究 等刀將瑜伽治療與常規(guī)護(hù)理干預(yù)CLBP進(jìn)行比較，使用疼痛強(qiáng) (哈他瑜伽輔助常規(guī)護(hù)理與單純的常規(guī)護(hù)理進(jìn)行比較)，他們將 度、疼痛頻率、睡眠、生活自理、工作、娛樂(lè)等主觀評(píng)分結(jié)合脊柱 干預(yù)時(shí)間延長(zhǎng)至1年，并于干預(yù)3、6,12個(gè)月后使用Roland功能 前屈、側(cè)屈的測(cè)量，結(jié)果顯示，瑜伽組的各項(xiàng)指標(biāo)總體緩解 障礙問(wèn)卷(Roland-Morris disability questionnaire,RMDQ)、亞伯丁 79%,明顯好于護(hù)理組，差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。 背部疼痛量表(Aberdeen back pain scale,ABPS)、疼痛自我效能 Tekur等81在印度辯喜瑜伽大學(xué)(Vivekananda Yoga Anu- 感問(wèn)卷(pain self-.efficacy questionnaire,PSEQ)對(duì)2組患者進(jìn)行評(píng) sandhana Samsthana,SVYASA)進(jìn)行了一項(xiàng)為期7d的短期密集 價(jià)，結(jié)果顯示，哈他瑜伽練習(xí)配合常規(guī)護(hù)理較單純常規(guī)護(hù)理，3 型瑜伽干預(yù)實(shí)驗(yàn)，以探討瑜伽練習(xí)對(duì)CLBP患者疼痛、脊柱功能 項(xiàng)指標(biāo)的改善均更為顯著，且隨著時(shí)間推移差異更為顯著，差異 和靈活性的作用。該研究將80例CLBP患者隨機(jī)分為瑜伽組 均有統(tǒng)計(jì)學(xué)意義(P<0.01)。該課題后續(xù)根據(jù)哈他瑜伽練習(xí)配 和物理鍛煉組，居住在集體宿舍進(jìn)行密集練習(xí)，瑜伽組練習(xí)內(nèi)容 合常規(guī)護(hù)理的患者僅有60%完成了12個(gè)月的瑜伽練習(xí)，又采 包括冥想、基礎(chǔ)體位法、唱誦和呼吸法等，物理鍛煉組進(jìn)行步行、 用不同分析方法對(duì)參與任一階段鍛煉的患者數(shù)據(jù)進(jìn)行再次分 特定姿勢(shì)練習(xí)、健康講座和音樂(lè)欣賞等，訓(xùn)練時(shí)間為早上5：00 析，結(jié)果顯示，依從子總體的平均因果效應(yīng)分析(complier aver 至22：00，練習(xí)7d后，瑜伽組的0 swestry功能障礙指數(shù)(Oswe- age causal effect analysis,CACE)比“符合方案分析”及按實(shí)際處 stry disability index,ODI)以及脊柱角度均顯著優(yōu)于物理鍛煉組， 理分析(per-protocol and on-treatment analyses)更為嚴(yán)謹(jǐn)i41,為 差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。同期，該課題組還采用世界衛(wèi) 此類研究提供了統(tǒng)計(jì)方法學(xué)的參考依據(jù)。 生組織生命質(zhì)量測(cè)定簡(jiǎn)表(the World Health Organization quality 以上的臨床研究表明，12周以上規(guī)律的瑜伽練習(xí)對(duì)腰痛癥 狀改善作用較為明顯，方法包括有針對(duì)性的瑜伽體式和呼吸法 D0I:10.3760/cma.j.issn.0254-1424.2015.09.021 以及艾揚(yáng)格瑜伽和哈他瑜伽。 基金項(xiàng)目：上海交通大學(xué)“科技創(chuàng)新專項(xiàng)資金”項(xiàng)目(11JCY11):國(guó)家 瑜伽與RA和KOA 體育總局氣功管理中心基金(QG2013004) 作者單位：200240上海，上海交通大學(xué)體育系（王會(huì)儒）：上海交通 瑜伽被較多地應(yīng)用于在RA的臨床輔助治療。Badsha 大學(xué)附屬新華醫(yī)院老年科（顧問(wèn)） 等在迪拜針對(duì)RA患者47例進(jìn)行了8周的程序化隨機(jī)對(duì)照 通信作者：王會(huì)儒，Email:gcsy@126.com 研究，對(duì)照組采用常規(guī)治療，實(shí)驗(yàn)組在常規(guī)治療的基礎(chǔ)上增加以

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中華物理醫(yī)學(xué)與康復(fù)雜志2015年9月第37卷第9期Chin J Phys Med Rehabil.September2015,Val.37.No.9 ·713· 椅子上練習(xí)為主的勝王瑜伽(Rajia Yoga),每周練習(xí)2次，每次 練習(xí)的昆達(dá)利尼瑜伽則更為適合。有研究比較了3個(gè)月阿斯湯 Ih。治療8周后，采用健康評(píng)定問(wèn)卷(health assessment ques- 噶瑜伽(Ashtanga Yoga)與無(wú)氧操練習(xí)對(duì)輕度高血壓患者的干預(yù) tionnaire,.HAQ)、生命質(zhì)量指數(shù)(quality of life,QOL)、SF-36簡(jiǎn)表 效果，結(jié)果發(fā)現(xiàn)，阿斯湯噶瑜伽對(duì)控制體重、降低血脂和控制血 評(píng)估生命質(zhì)量和28項(xiàng)疾病活動(dòng)性評(píng)分(disease activity score, 壓等有一定作用，但與其他運(yùn)動(dòng)比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P> DAS28)評(píng)價(jià)勝王瑜伽對(duì)2組患者的療效，結(jié)果顯示，實(shí)驗(yàn)組患0.05)241。該研究提示.阿斯湯噶瑜伽可能對(duì)心腦血管病疾病 者的DAS28指數(shù)和HA0指數(shù)較對(duì)照組改善更為顯著，差異均也有一定作用。 有統(tǒng)計(jì)學(xué)意義(P<0.01),而00L評(píng)分2組間差異無(wú)統(tǒng)計(jì)學(xué)意 一項(xiàng)針對(duì)冠心病患者170例的隨機(jī)對(duì)照研究顯示]，經(jīng)過(guò) 義(P>0.05)。有學(xué)者進(jìn)行了一項(xiàng)每周3次、每次75mim,為期 為期6個(gè)月，每周5次的瑜伽呼吸法和瑜伽潔凈法練習(xí)后，患者 10周的小型干預(yù)研究，結(jié)果顯示，瑜伽干預(yù)可改善RA患者的 的血管收縮壓、舒張壓及心率均得到控制，總膽固醇(P< HAQ指數(shù)，緩解關(guān)節(jié)疼痛和由疾病所致的抑郁狀態(tài)6]。Evans 0.01),甘油三酯(P<0.01),高密度脂蛋白(P<0.01)和低密度 等71針對(duì)18歲-35歲的青年RA患者進(jìn)行了6周的艾揚(yáng)格瑜 脂蛋白(P<0.05)均顯著改善，該研究認(rèn)為，瑜伽呼吸法和放松 伽干預(yù)和2個(gè)月的隨訪，結(jié)果顯示，青年RA患者的HAQ指數(shù)、 類體式練習(xí)有益于冠狀動(dòng)脈疾病患者。Pullen等]針對(duì)心衰 SF-36簡(jiǎn)表以及疼痛障礙指數(shù)(pain disability index,PDI)較組內(nèi) 患者進(jìn)行了瑜伽干預(yù)，結(jié)果發(fā)現(xiàn)，經(jīng)過(guò)每周2次，每次40min,持 治療前均顯著改善，差異均有統(tǒng)計(jì)學(xué)意義(P<0.01),即艾揚(yáng)格 續(xù)12周的瑜伽體式結(jié)合呼吸法練習(xí)后，心力衰竭患者的明尼蘇 瑜伽可作為年輕RA患者的補(bǔ)充療法，但還需要更多樣本的支 達(dá)心衰生命質(zhì)量問(wèn)卷(Minnesota living with heart failure question~ 持。后續(xù)研究中，Evans等]針對(duì)18歲-35歲的青年RA患者 naire,MHFQ)評(píng)分以及炎癥因子指標(biāo)均顯著改善，該研究提 進(jìn)行了艾揚(yáng)格瑜伽干預(yù)，每周2次，每次90min,連續(xù)千預(yù)6周. 出，瑜伽可作為心衰常規(guī)治療的輔助。另有2項(xiàng)研究也提示，瑜 本次研究Evans等增加了血壓，心率，DAS28和風(fēng)濕性關(guān)節(jié)炎自 伽練習(xí)對(duì)心血管疾病具有輔助治療作用]。 我效能量表(arthritis self-.efficacy scale,ASES)等評(píng)價(jià)指標(biāo)，結(jié)果 Holger等]對(duì)瑜伽在心血管疾病的應(yīng)用及其療效進(jìn)行了 再次肯定了艾揚(yáng)格瑜伽對(duì)RA的療效，即艾揚(yáng)格瑜伽可顯著減 薈萃分析，共納入44項(xiàng)臨床實(shí)驗(yàn)和3168例心血管患者，最終分 輕RA患者的臨床癥狀，舒緩情緒，提高生命質(zhì)量。還有研究提 析指出，盡管多項(xiàng)隨機(jī)臨床研究存在偏移系數(shù)高、方法缺陷等問(wèn) 出，哈他瑜伽可作為RA門診患者輔助治療方法[) 題，但瑜伽作為普通心血管疾病患者的臨床輔助干預(yù)手段，其具 瑜伽對(duì)KOA的輔助治療也有一定效果。Ebnezar等01進(jìn) 備一定療效的結(jié)論可以采信。 行了一項(xiàng)針對(duì)骨關(guān)節(jié)炎患者的大型隨機(jī)對(duì)照研究，250例K0A 患者(35-80歲)被隨機(jī)分為哈他瑜伽組和物理治療組，2組分 瑜伽與2型糖尿病 別進(jìn)行每天20min,持續(xù)3個(gè)月的干預(yù).結(jié)果表明，哈他瑜伽治 隨著肥胖的不斷普遍化，2型糖尿病(type2 diabetes melli- 療在改善關(guān)節(jié)疼痛、膝關(guān)節(jié)活動(dòng)度、腫脹，關(guān)節(jié)摩擦、關(guān)節(jié)功能等 s,T2DM)及其引發(fā)的并發(fā)癥危害日益嚴(yán)重。越來(lái)越多的證據(jù) 方面優(yōu)于經(jīng)皮電刺激療法和超聲波療法。W等2]用包括坐 表明，喻伽不僅有助于T2DM及其并發(fā)癥的臨床管理，還可控制 在椅子上的瑜伽體式練習(xí)結(jié)合印度阿育吠陀(Ayurvedic)治療 2型糖尿病的發(fā)展，改善糖耐量異常，降低胰島素抵抗，但尚缺 法對(duì)KOA進(jìn)行輔助治療，用西安大略和麥克馬斯特骨關(guān)節(jié)炎指 乏大型的隨機(jī)對(duì)照臨床試驗(yàn)來(lái)證實(shí)o。Hegde等3]針對(duì) Western Ontario and MeMaster University Osteoarthritis Index, T2DM患者進(jìn)行了為期3個(gè)月的哈他瑜伽體位法干預(yù)，結(jié)果發(fā) WOAMAC)指數(shù)，PDI指數(shù)和OOL指數(shù)等進(jìn)行評(píng)價(jià)，結(jié)果也肯定 現(xiàn)，瑜伽練習(xí)可控制T2DM患者的血糖水平，降低其氧化應(yīng)激水 了瑜伽輔助治療對(duì)KOA的作用。 平和BMⅡ指數(shù)，且對(duì)糖尿病前期的患者也有一定作用。有研究 可能是由于活動(dòng)受限，關(guān)節(jié)疼痛等因素的影響，患者依從性 發(fā)現(xiàn)，綜合瑜伽治療可顯著降低絕經(jīng)后女性糖尿病患者的空腹 較低，目前瑜伽干預(yù)KOA的大樣本隨機(jī)對(duì)照研究較少。對(duì)RA 血糖、總膽固醇、甘油三酯和低密度脂蛋白-膽固醇水平，其療效 及KOA患者而言，改良的哈他瑜伽和勝王瑜伽體式練習(xí)相對(duì)安 顯著優(yōu)于單純的藥物治療321。Hegde等]在糖尿病前期患者 全。Middleto等]在美國(guó)主持了一項(xiàng)國(guó)家關(guān)節(jié)肌肉骨骼及皮膚 的隨機(jī)對(duì)照研究中發(fā)現(xiàn)，以社區(qū)為試點(diǎn)的哈他瑜伽體式干預(yù)可 病研究所項(xiàng)目，該研究旨在從患者的接受度和可行性方面，探討 以有效地控制患者氧化應(yīng)激水平，降低其B指數(shù)、腰圍、血壓 瑜伽作在KOA臨床治療的應(yīng)用前景，以期獲得更多的臨床數(shù)據(jù) 以及血糖水平，但該結(jié)果還有待更大樣本量的支持。Rao等34] 支持。 在研究中將T2DM患者227例按隨機(jī)數(shù)字表法分為整合瑜伽組 瑜伽與高血壓、冠心病 和體育鍛煉組，整合瑜伽組遵循瑜伽生活規(guī)范，有規(guī)律地練習(xí)瑜 伽體式、呼吸法和冥想，體育鍛煉組則采用健身體操進(jìn)行鍛煉 瑜伽練習(xí)具有控制血壓的效果。Walf等2]將83例20~ 結(jié)果發(fā)現(xiàn)，2組患者各練習(xí)9個(gè)月后，整合瑜伽組整體干預(yù)效果 80歲的高血壓患者隨機(jī)分為瑜伽練學(xué)習(xí)班組，居家簡(jiǎn)易瑜伽練 明顯優(yōu)于體育鍍煉組。McDermott等]的研究也認(rèn)為，瑜伽生 習(xí)組和對(duì)照組，進(jìn)行了為期12周的干預(yù)實(shí)驗(yàn)，對(duì)照組維持常規(guī) 活方式干預(yù)T2DM可減輕忠者的體重和腰圍，控制其空腹血糖 治療方案，喻加練習(xí)班增加較為復(fù)雜的哈他瑜伽練習(xí)，居家練習(xí) 且療效優(yōu)于步行鍛煉。Gaurav等36在Rao等34研究基礎(chǔ)上， 組增加相對(duì)簡(jiǎn)單的昆達(dá)利尼瑜伽(Kundalini Yoga)練習(xí)，結(jié)果發(fā) 對(duì)整合瑜伽組T2DM患者進(jìn)行了4年的隨訪，結(jié)果發(fā)現(xiàn)，堅(jiān)持瑜 現(xiàn)，瑜伽練學(xué)習(xí)班組患者的血壓和生命質(zhì)量無(wú)明顯改變，而居家 伽練生活方式的患者空腹血糖控制情況優(yōu)于未能堅(jiān)持瑜伽練生 瑜伽練習(xí)組的血壓和生命質(zhì)量改善明顯，與對(duì)照組比較，差異均 活方式的患者，且空腹血糖和壓力呈正相關(guān)(r=0.42,P< 有統(tǒng)計(jì)學(xué)意義(P<0.05)。該研究認(rèn)為，哈他瑜伽體式復(fù)雜，對(duì) 0.05),該研究結(jié)果提示，瑜伽練習(xí)可改善T2DM患者的精神狀 身體柔韌性要求高，不適合高血壓患者，而動(dòng)作簡(jiǎn)單、適合居家 態(tài)和對(duì)生活的熱情，而血糖指標(biāo)和壓力是影響堅(jiān)持瑜伽練習(xí)的

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·714· 中華物理醫(yī)學(xué)與康復(fù)雜志2015年9月第37卷第9期Chin J Phys Med Rehabil.September2015,Val.37.No.9 重要因素。Kyizom等1觀察了瑜伽呼吸法結(jié)合體式練習(xí)對(duì) 尚難確定哪種瑜伽更具針對(duì)性的療效。 T2DM患者事件相關(guān)電位潛伏期和振幅的影響，結(jié)果發(fā)現(xiàn).瑜伽 艾揚(yáng)格瑜伽以著名瑜伽導(dǎo)師B.K.S Iyengar的名字命名，又 組（體式+呼吸法+清潔法+常規(guī)藥物治療）患者的事件相關(guān) 稱為輔助瑜伽，其最大特點(diǎn)是借助椅子，靠墊、磚頭等輔助工具， 電位N200和P300的潛伏期以及振幅均顯著優(yōu)于常規(guī)藥物治 使瑜伽體式變得簡(jiǎn)單，更加適合不同人群的生理特點(diǎn)。艾揚(yáng)格 療組（單純的常規(guī)藥物治療），提示常規(guī)藥物治療結(jié)合瑜伽練習(xí) 瑜伽其實(shí)是哈他瑜伽經(jīng)典體式的人性化革新，因此受眾面較廣。 可改善糖尿病患者的認(rèn)知功能。 針對(duì)KOA患者，可采用改良的、椅子上的改良瑜伽體式練習(xí)，以 綜上所述，可以認(rèn)為，T2DM患者遵循瑜伽倡導(dǎo)的生活方 降低膝關(guān)節(jié)的承受力。阿斯湯噶瑜伽的難度和強(qiáng)度均非常高 式，有規(guī)律地練習(xí)瑜伽體式和呼吸法可使其肢體放松、壓力緩 (如倒立類、力量類練習(xí))，無(wú)基礎(chǔ)的健康人也很難完成，因此不 解，有助于控制血糖，改善其認(rèn)識(shí)功能和精神狀態(tài)，從而達(dá)到輔 太適合于心血管及關(guān)節(jié)問(wèn)題的患者。昆達(dá)利尼瑜伽是由一 助治療糖尿病的目的。 系列的瑜伽動(dòng)作組合組成的，呼吸法和唱誦較多，對(duì)柔韌性要求 不高，可建議心血管疾病、腫瘤以及壓力大者練習(xí)。如何從上百 瑜伽與乳腺癌 種的瑜伽體式，以及呼吸法和冥想練習(xí)中，根據(jù)疾病的特點(diǎn)制定 有研究顯示，瑜伽干預(yù)可作為腫瘤（如乳腺癌）的輔助治療 個(gè)性化的瑜伽練習(xí)處方，可能是未來(lái)需要解決的問(wèn)題。 方案。Carson等81（瑜伽覺(jué)知練習(xí)8周）、Bower等91（艾揚(yáng)格 瑜伽倡導(dǎo)科學(xué)的生活方式，從飲食習(xí)慣到日常作息，均有明 瑜伽練習(xí)12周)和Banasik等o](艾揚(yáng)格瑜伽8周)的瑜伽干 確的規(guī)定：而瑜伽呼吸控制法和瑜伽冥想還具有心理疏導(dǎo)的作 預(yù)研究均顯示，規(guī)律的瑜伽練習(xí)可改善乳腺癌存活者的持續(xù)疲 用。如何借鑒國(guó)外研究成果，將瑜伽治療運(yùn)用于臨床實(shí)踐中，減 勞癥狀，增加活力。Littman等4]研究結(jié)果顯示，6個(gè)月的哈他 輕患者的痛苦，降低藥物治療的頻率和減少副反應(yīng)，是國(guó)內(nèi)醫(yī)務(wù) 瑜伽練習(xí)不足以改善乳腺癌患者的疲勞癥狀，須進(jìn)行更長(zhǎng)時(shí)間 工作者需要努力的方向。 的練習(xí)。Moadel等4]的研究提出，增加瑜伽練習(xí)的強(qiáng)度才可改 善乳腺癌患者的疲勞癥狀。Chandwani等4]的研究也發(fā)現(xiàn)，6 參考文獻(xiàn) 周的瑜伽練習(xí)可以改善乳腺癌患者的生命質(zhì)量，但未見(jiàn)疲勞狀 [1]Posadzki P,Emst E.Yoga for low back pain:a systematic review of 態(tài)的明顯改善。Danhauer等[4的研究則發(fā)現(xiàn)，治療12周后，瑜 randomized clinical trials[J].Clin Rheumatol,2011,30(9):1257- 伽練習(xí)組（能量修復(fù)瑜伽+常規(guī)藥物治療）的情緒和藥物治療 1262. 的副反應(yīng)情況均優(yōu)于常規(guī)藥物組(P<0.05),但2組間的疲勞 [2]陳士強(qiáng)。瑜伽的生理心理功效研究進(jìn)展[J].中國(guó)運(yùn)動(dòng)醫(yī)學(xué)雜志， 2012,31(8):740-745. 癥狀差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。 [3]Field T.Yoga clinical research review [J].Complement Ther Clin 在對(duì)乳腺癌癥患者進(jìn)行治療的過(guò)程中，心理健康問(wèn)題常被 Pract..2011.17(1):1-8. 忽略。Mackenzie等451的研究結(jié)果顯示，經(jīng)6個(gè)月的瑜伽冥想 [4]Derry HM,Jaremka LM,Bennett JM,et al.Yoga and self-reported 干預(yù)，乳腺癌患者的不安情緒、抑郁癥狀及健康相關(guān)生命質(zhì)量 cognitive problems in breast cancer survivors:a randomized controlled (health-related quality of life,HRQL)均顯著改善。Kovacie等6] trial[J].Psychooncology,2014,DOI:10.1002/pon.3707. 的研究結(jié)果也顯示，系統(tǒng)的瑜伽生活方式可改善乳腺癌術(shù)后患 [5]Cramer H,Rabsilber S,Lauche R,et al.Yoga and meditation for 者的焦慮情緒，壓力和自我認(rèn)知度。還有研究認(rèn)為，瑜伽呼吸法 menopausal symptoms in breast cancer survivors-A randomized con- 不僅可以提高乳腺腫瘤化療患者的生命質(zhì)量，還可改善其焦慮 trolled trial[J].Canner,2015,DOI:10.1002/cancer.29330 抑郁，睡眠障礙等癥狀t4。Cramer等[s]對(duì)瑜伽干預(yù)乳腺癌的 [6]Sherman KJ,Cherkin DC,Wellman RD,et al.A randomized trial 臨床研究進(jìn)行了薈萃分析，共納入12項(xiàng)隨機(jī)對(duì)照研究和472例 comparing yoga,stretching,and a self-care book for chronic low back 患者，結(jié)果發(fā)現(xiàn)，短期的瑜伽練習(xí)可作為乳腺癌患者的輔助恢復(fù) paim[J].Arch Intern Med,2011,171(22):2019-2026 [7]Pushpika A,Somarathna AM,Vyas KI,et al.Clinical evaluation of 方法，其療效基本可以肯定。 selected Yogic procedures in individuals with low back pain[J].Ayu 小結(jié) 2010.31(2):245-250. (8]Tekur P,Singphow C,Nagendra HR,et al.Effect of short-term inten- 已有大量臨床實(shí)驗(yàn)證實(shí)，瑜伽可作為疾病的輔助治療手段， sive yoga program on pain,functional disability and spinal flexibility in 但實(shí)驗(yàn)設(shè)計(jì)和研究方法等方面還有值得商討之處。如入選標(biāo)準(zhǔn) chronic low back pain:a randomized control study[J].J Altern Com- 和干預(yù)周期不統(tǒng)一，評(píng)價(jià)方法主要采用問(wèn)卷和主觀打分，患者的 plement Med,2008.14(6):637-644. 依從性低和隨訪流失等問(wèn)題，使結(jié)果難以讓人完全信服。近年 [9]Tekur P,Chametcha S,Hongasandra RN,et al.Effect of yoga on 來(lái)，有研究者嘗試采用更為嚴(yán)謹(jǐn)、偏差性較小的統(tǒng)計(jì)方法來(lái)解決 quality of life of CLBP patients:a randomized control study[.Int J 上述部分問(wèn)題。這對(duì)于研究中國(guó)傳統(tǒng)健身方式（如太極拳）的 Yoga,2010,3(1):10-17. 疾病干預(yù)極具參考價(jià)值。 [10]Michalsen A,Jeitler M,Brunnhuber S,et al.lyengar yoga for dis- tressed women:a 3-armed randomized controlled trial[J].Evid Based 應(yīng)用于臨床干預(yù)的瑜伽種類呈多樣化，包括艾揚(yáng)格瑜伽、哈 Complement Alternat Med,2012,(2012):539-539. 他瑜伽，瑜伽清潔法、阿斯湯噶瑜伽、昆達(dá)利尼瑜伽、能量修復(fù)瑜 [11]Williams KA,Petronis J,Smith D,et al.Effect of lyengar yoga thera 伽以及瑜伽生活方式等，其中艾揚(yáng)格瑜伽應(yīng)用較多。由于目前 py for chronic low back pain[J].Pain,2005,115(1):107-117. 的實(shí)驗(yàn)設(shè)計(jì)中，一般將常規(guī)藥物治療的非鍍煉組、健康教育，或 [12]Saper RB,Sherma K],Cullum DD,et al.Yoga for chronie low back 者其它運(yùn)動(dòng)作為對(duì)照組，較少采用不同瑜伽種類進(jìn)行比較，因此 pain in a predominantly minority population:a pilot randomized con-

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·716· 中華物理醫(yī)學(xué)與康復(fù)雜志2015年9月第37卷第9期Chin J Phys Med Rehabil.September2015,Val.37.No.9 cording to the Yoga In Daily Life(R)system on anxiety after breast er,2012,12(27):412. cancer surgery[J].J Complement Integr Med,2013,16(7):10. [49]Bhavanani AB.RamanathanM,Balaji R,et al.Comparative immediate [47]Dhruva A,Miaskowsk C,Abrams D,et al.Yoga breathing for cancer effect of different yoga asanas on heart rate and blood pressure in chemotherapy-associated symptoms and quality of life:results of a pilot healthy young volunteers[]Int J Yoga,2014.7(2):89-95. randomized controlled trial[]J Altern Complement Med,2012.18 (5):473479. (修回日期：20150801) [48]Cramer H,Lange S,Klose P,et al.Yoga for breast cancer patients (本文編輯：阮仕衡) and survivors:a systematic review and meta-analysis[J].BMC Canc- ·外刊擷英· Antidepressant use and cognitive decline BACKGROUND AND OBJECTIVE Depression is consistently associated with cognitive impairment and increased risk for dementia. This study was designed to better understand the association between pharmacologic treatment of depression and cognitive decline. METHODS Data for this study were derived from the nationally representative Health and Retirement Study(HRS)and the HRS Pre- scription Drug Study (PDS),which included serial assessments of cognitive function,depression and antidepressant treatment.Data were drawn from the 2004,2006,2008 and 2010 findings of the HRS and from the 2005 and 2007 findings of the PDS.Baseline depression status was determined using the 2004 wave of the HRS. RESULTS Of the 3,714 respondents,12%were taking antidepressant medication at baseline.No significant differences were detected in cognition scores between the patients taking antidepressants and those who were not.At six year follow-up,both users and nonusers of an- tidepressants had experienced a cognitive decline.Adjusted analysis revealed that cognitive decline did not differ between those taking and those not taking antidepressant medications. CONCLUSION This longitudinal study of a population representative cohort of older adults found that antidepressant use is not associ- ated with changes in cognitive function over a six-year period. [Saczynski JS,Rosen AB,McCammon RJ,et al.Antidepressant use and cognitive decline:the health and retirement study.A- mer J Med.2015,128(7):739-746.】 Obesity paradox in type ii diabetes BACKGROUND AND OBJECTIVE The association between obesity and an increased risk for cardiovascular disease is well estab- lished.However,there is growing evidence that overweight patients with cardiovascular disease survive longer than do their normal weight counterparts,an effect referred to as the "obesity paradox".This study was designed to determine whether such a paradox exists among pa- tients with diabetes mellitus (DM). METHODS Patients with known type II DM diabetes,followed in a British clinic,were enrolled in an electronic database from 1995 to 2005.Data collected included comorbid conditions,age,diabetes history and duration,smoking history,height,weight and blood pressure, collected at the time of the initial visit.This cohort was followed for clinical events until 2011.The primary outcome measure was all-cause mortality,with the secondary outcome being hospitalizations for cardiovascular events. RESULTS A total of 10,568 patients with an average age of 63 years were followed for an average of 10.6 years.Overweight or obese patients had a higher rate of cardiac events requiring hospitalizations than did those with normal weight.However,the risk for cerebrovascular accidents was greater only in those with a body mass index of 30 to 34.9 kg/m and among those in the 57 to 67 year age group.Assessment of mortality risk of those hospitalized for these events revealed a survival advantage for higher body mass index categories (P<0.001 )A Cox regression analysis demonstrated that those who were overweight had a reduced mortality risk as compared to normal weight individuals, while those who were obese had a similar mortality risk as those with normal weight.The lower mortality risk conferred by being overweight or obese developed around age of 60 years. CONCLUSION This study of patients with type II diabetes found that being overweight or obese was associated with a higher risk of nonfatal cardiovascular events,but not a higher risk of mortality. [Costanzo P,Cleland JG,Pellicori P,et al.The Obesity Paradox in Type II Diabetes Mellitus:Relationship with Body Mass In- dex to Prognosis.Ann Intern Med,2015,162(9):610-618.]

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